Health literacy has emerged as an important construct because it's four components: cultural and conceptual knowledge, listening and speaking (oral literacy), writing and reading (print literacy), and numeracy affect the health outcomes of individuals. As individuals don't live in a vacuum, it is important to understand the complex interaction of health literacy at multiple levels of interaction from the individual to the family, health care system and community. Describing how these multiple points of view connect and influence each other for individuals with cancer and other chronic illnesses, from rural Appalachian communities who are in a rehabilitation setting is the under explored focus of this study. The current study is the first step in developing a program of research designed to address these complex interactions and gaps in the literature. Through in-depth interviews and focus groups, the goal of the present study is to explore the influence of health literacy from the individual, family, health care facility and the patient's rural home community point of view. We propose to achieve three specific aims: 1.) Describe the health literacy level of this population. 2.) Determine the supports and barriers found in an inpatient rehabilitation facility in terms of facilitating health communication and addressing potential health literacy issues. 3.) Address the impact of health literacy on the transition from a rehabilitation facility back to a person's rural home community. This descriptive pilot study is a critical first step toward our ultimate goal of developing and empirically assessing health literacy interventions for this population. Later inquiries will include an examination of current processes in a rehabilitation setting and how they positively or negatively support health communication particularly in terms of health literacy in rural populations. The long-term goal is to develop interventions that will decrease the barriers and enhance the supports in health communication to decrease poor health outcomes, decrease health disparities in rehabilitation and positively influence transitions between settings for individuals with cancer and other chronic disease. PUBLIC HEALTH RELEVANCE: Low health literacy has the potential to negatively impact individuals with cancer and other chronic illness who are in a rehabilitation setting in terms of health and well-being. Low health literacy can negatively impact issues such as self-management of cancer and other chronic illness and medication adherence. This problem is possibly compounded if the individual is from a rural community, transplanted to a metropolitan inpatient rehabilitation setting and then sent back to their rural community. It is important to understand how low health literacy interacts with the individual in their complex social setting, including family, health care setting and home community with the goal of reducing potential health disparities among this population.